Fractured Cusp

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What is a Fractured Cusp?

Damage to teeth can present in many ways, but a very common injury is a fractured cusp. All of the posterior molars have elevations called cusps that help you chew and give our teeth anatomy. Most molars have four or five cusps. 

fractured cusp

When tooth decay or an injury occurs, it can cause the top portion of a tooth, or tooth cusp, to fracture. Fortunately, modern dentistry offers numerous ways to prevent a fractured cusp, but if it does happen, there are dental treatments to help restore our teeth to proper function. 

Other Types of Tooth Fractures

It is always essential to get a proper diagnosis from your dentist on what types of cracks you have. This will impact your treatment, cost, and oral health. The most common types of tooth fractures are: 

  • Craze lines superficial tiny cracks in the enamel. They usually occur in adult teeth, don’t cause any harm, and are monitored by your dentist.
  • Split tooth — results from tooth decay or an injury that causes two distinct segments. This can be treated with root canal therapy, if salvageable, or extraction.
  • Root fracture —  this commonly occurs from a dental trauma. A vertical root fracture exists from the root and can vary in severity. Oftentimes, an endodontic procedure can help save the tooth. 
  • Cracked tooth —  when there is a crack that extends below the gum line, it can damage the pulp. This can be painful and likely requires root canal treatment. 

What Causes a Fractured Tooth Cusp?

Fractured Cusp 3-d Depiction

The most common causes of a fractured cusp include:

  • Severe tooth decay — untreated tooth decay that extends to a large portion of the tooth can cause a fractured cusp. This is because cavities weaken teeth by breaking down the hard outer enamel surface to a softer, weaker structure. 
  • Chronic grinding and clenching — if you grind your teeth, you have a common condition called bruxism. When you clench your teeth over time, the chronic biting pressure can cause your teeth to put such strong forces on the tooth cusps.
  • Trauma — dental injuries are responsible for many fractured teeth. Wearing a mouth guard during contact sports is important to help prevent fractured cusps, pain, and long-term dental problems. 
  • Failed restoration — sometimes, a dental filling isn’t sufficient to help restore a tooth. If you have a large filling, it may fail and cause a fractured cusp. In other cases, recurrent decay causes a weakened restoration and tooth, causing the tooth to crack. 
  • Biting into hard food — it is never wise to bite directly into really hard candy or food because you can fracture your cusp. It is better to cut hard pieces of food up or avoid hard or sticky foods altogether. 

Symptoms of a Fractured Tooth Cusp

Symptoms may vary depending on the severity of your fractured cusp. If you have a small chip, you may be unaware your tooth has a fracture. Some people who chronically grind their teeth slowly wear away the tooth enamel so that a protective, reparative dentin layer forms and sensitivity is low. Common symptoms of a fractured tooth include:

  • Temperature sensitivities
  • Sharp edge of your tooth with your tongue 
  • Sharp pain when chewing
  • Gum discomfort

Fractured Cusp, No Pain?

A fractured cusp does not always cause pain. However, it is important to follow up with your dentist to determine if you need a small filling, a dental crown, or a more involved treatment like a root canal (if the tooth is necrotic). If there is significant damage done to your tooth, you may be referred to an endodontist.

Usually, a fractured cusp in adult teeth does not injure the pulp and requires repair by a filling or dental restoration. When a broken cusp only affects the chewing surface, it may not cause any symptoms at all. 

How to Prevent Tooth Fractures

Sometimes tooth trauma is unpreventable. Fortunately, there are a few ways you can help prevent tooth fractures in certain situations. For example: 

  1. Wear an athletic mouthguard when you play sports to avoid trauma. 
  2. If you are a teeth grinder while sleeping, discuss getting a custom night guard from your dentist to help prevent tooth fractures. It would be best if you always tried to attend routine dental visits to ensure no dental problems need to be addressed. 
  3. Avoid biting into hard objects or foods that may cause extensive cracks in your teeth. 
  4. If you have dental treatment to be completed, do not wait long to create more complex oral health issues. The longer you wait, the more risk you have for injuring your teeth and loss of the tooth.

Fractured Cusp Treatment

If you have a fractured cusp, you will benefit from various treatments to help avoid pain and infection. Depending on the severity of the fractured cusp and the extent of the crack, your dental treatment can range from non-invasive to extensive work.

  1. Dental filling — if a small piece of your tooth cusp breaks, the dentist may be able to restore your tooth with a dental filling. This will help avoid the tooth from having sharp edges and becoming more susceptible to tooth decay and sensitivity. 
  2. Dental crown — if a large piece of your tooth fractures, you may benefit from a full crown. A crown covers the entire tooth and restores form and function to your natural tooth. A dental crown is a permanent, long-term option that helps avoid future cracking.
  3. Dental inlay or onlay — depending on the amount and area of your fractured cusp, you may be a good candidate for an inlay or onlay. These types of treatments help restore your tooth and usually fall within a filling and crown. An inlay or onlay will cover a portion of the tooth, but not as extensive as a dental crown. They are made from a dental laboratory and are beneficial to increase a tooth’s strength up to 75%.
  4. Root canal treatment — if your fractured cusp is severe, you may require root canal therapy to help restore the tooth. It is typical that a fractured cusp does not involve the pulp, but in the case of a large cusp fracture, this may be a treatment option. 

When is a Fractured Cusp an Emergency?

If you fracture a cusp of your tooth, do not panic. There are very few dental emergencies that cannot be easily managed at home before your dental visit. However, early diagnosis and treatment are always important to avoid a dental emergency. If you experience any of the following, you should consider a fractured cusp an emergency and visit your dentist immediately:

  • Extreme pain that cannot be relieved with over-the-counter medication
  • Facial swelling
  • Abscess

Do Fractured Teeth Heal Completely? 

If you have a fractured tooth, it will not heal on its own. Unlike other bones in your body, teeth require some restoration treatment to avoid ongoing problems. Without treatment, a fractured tooth can continue to progress and cause pain, infection, and even tooth loss.

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